Remote Appeals Medical Director (MD/DO) - Health Plan

UnitedHealthcare; Cypress (CA); Hybrid; USD 249,000 - 373,000; Full time

Benefits offered by this job

Comprehensive benefits

Equity stock purchase

401k contribution

Incentive programs

Recognition programs

Job summary

UnitedHealthcare, part of UnitedHealth Group, is seeking an Appeals and Grievances Medical Director to oversee clinical review and adjudication of appeals across plans (PPO, HMO, MAPD, PDP). This role offers remote work from anywhere in the U.S., with in-office requirements for Minneapolis or Washington, D.C.

area colleagues four days per week. MD or DO with active license and Board Certification in an ABMS/AOBMS specialty, 5+ years of clinical practice, 2+ years in Quality Management, strong

Qualifications

• MD or DO with an active, unrestricted license.
• Board Certified in an ABMS or AOBMS specialty.
• 5+ years of clinical practice experience.
• 2+ years of Quality Management experience.
• Familiarity with current medical issues and practices.
• Intermediate or higher level of proficiency with managed care.
• Proven telephonic communication and interpersonal skills.
• Strong project management and data analysis abilities.
• Excellent presentation skills for clinical and non-clinical audiences.
• Creative problem-solving skills and solid teamwork.

Responsibilities

• Perform individual case review for appeals and grievances across plans (PPO, HMO, MAPD, PDP).
• Respond to Department of Insurance/DMHC and CMS regulatory requests.
• Communicate rationales and interpretations to medical directors and staff.
• Participate in meetings on improvement, training, and program results.
• Provide clinical and strategic input on committees and projects.

Job description

UnitedHealthcare, part of UnitedHealth Group, is seeking an Appeals and Grievances Medical Director to oversee clinical review and adjudication of appeals across plans (PPO, HMO, MAPD, PDP). This role offers remote work from anywhere in the U.S., with in-office requirements for Minneapolis or Washington, D.C.

area colleagues four days per week. MD or DO with active license and Board Certification in an ABMS/AOBMS specialty, 5+ years of clinical practice, 2+ years in Quality Management, strong